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01-11-2003 | Original

Impact of positive end-expiratory pressure on the definition of acute respiratory distress syndrome

Authors: Elisa Estenssoro, Arnaldo Dubin, Enrique Laffaire, Héctor S Canales, Gabriela Sáenz, Miriam Moseinco, Pierina Bachetti

Published in: Intensive Care Medicine | Issue 11/2003

Abstract

Objective

We examined whether PEEP during the first hours of ARDS can induce such a change in oxygenation that could mask fulfillment of the AECC criteria of a PaO₂/FIO₂ ≤ 200 essential for ARDS diagnosis.

Design and setting

Observational, prospective cohort in two medical-surgical ICU in teaching hospitals.

Patients

48 consecutive patients who met AECC criteria of ARDS on 0 PEEP (ZEEP) at the moment of diagnosis.

Measurements and results

PaO₂/FIO₂ and lung mechanics were recorded on admission (0 h) to the ICU on ZEEP, and after 6, 12, and 24 h on PEEP levels selected by attending physicians. Lung Injury Score (LIS) was calculated at 0 and 24 h. PaO₂/FIO₂ rose significantly from 121±45 on ZEEP at 0 h, to 234±85 on PEEP of 12.8±3.7 cmH₂O after 24 h. LIS did not change significantly (2.34±0.53 vs. 2.42±0.62). These variables behaved similarly in pulmonary and extrapulmonary ARDS, and in survivors and nonsurvivors. After 24 h only 18 patients (38%) still had a PaO₂/FIO₂ of 200 or lower. Their mortality was similar to that in the remaining patients (61% vs. 53%).

Conclusions

The use of PEEP improved oxygenation such that one-half of patients after 6 h, and most after 24 h did not fulfill AECC hypoxemia criteria of ARDS. However, LIS remained stable in the overall series. These results suggest that PEEP level should be taken into consideration for ARDS diagnosis.

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Title: Impact of positive end-expiratory pressure on the definition of acute respiratory distress syndrome
Authors: Elisa Estenssoro
Arnaldo Dubin
Enrique Laffaire
Héctor S Canales
Gabriela Sáenz
Miriam Moseinco
Pierina Bachetti
Publication date: 01-11-2003
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 11/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-003-1943-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of positive end-expiratory pressure on the definition of acute respiratory distress syndrome

Abstract

Objective

Design and setting

Patients

Measurements and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design and setting

Patients

Measurements and results

Conclusions

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